Provider Demographics
NPI:1700989167
Name:LEE MCNAIR, MARY A (CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:LEE MCNAIR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ALICE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1736
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:
Practice Address - Street 1:1175 CASCADE PARKWAY
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS & GYNECOLOGY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311
Practice Address - Country:US
Practice Address - Phone:404-505-4141
Practice Address - Fax:404-505-4177
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN068122207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
50BBHTKMedicare ID - Type Unspecified
Q25568Medicare UPIN